Third-Party Advisory/Consulting Services Request Form
Company Name
Type of Company (i.e. payroll service provider, debit collection)
Company Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
Does your company provide ACH origination services to any Nested Third-Party Senders?
Yes
No
Does your company have multiple business units or segments processing ACH origination activity?
Yes
No
What Advisory/Consulting services are you interested in?
ACH Policies, Procedures & Agreements Review
ACH Origination
Operational Processes
Other
What are your preferred timeframes?
(Please list 3 dates or timeframes that work best for you.)
Timeframe option 1
*Dates subject to availability
Timeframe option 2
*Dates subject to availability
Timeframe option 3
*Dates subject to availability
Preferred Contact Method
Email
Telephone
What prompted you to contact us about our services? (Choose one)
Email
Postcard/letter/direct mail
Conference or other event
Referred by my financial institution
Prior use of audit services
EPCOR Website
Other
Please verify that you are human
*
Submit
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